Misunderstandings
about serodiscordance and limited understanding of female fertility and male
insemination are barriers to couples in serodiscordant partnerships in attempting to
practice safer conception methods, according to a qualitative study presented
by Rebecca Phofa at the 7th South
African AIDS Conference in Durban last month.

Safer
conception preferences were largely influenced by an assessment of the
effectiveness of the intervention at reducing or eliminating risk, concerns
over side-effects of antiretroviral treatment (ART) and knowledge about the method.

Safer
conception services are needed to reduce both horizontal and vertical
transmission risks among serodiscordant couples trying to become pregnant.
Several strategies exist to address this, including early initiation of ART for
HIV-positive partners, independent of CD4 count, with viral load monitoring to
confirm viral load suppression; pre-exposure prophylaxis (PrEP) for
HIV-negative partners; condomless sex limited to the peri-ovulation period; or
manual self-insemination using a plastic syringe if the male partner is
HIV-negative.

In-depth
interviews and focus groups were held in English, Zulu and Sotho and
facilitated by trained researchers using semi-structured interview guides
between February and July 2013 with women and men who were in a relationship
with an HIV-positive partner and were hoping to have a child in the near
future.

Barriers to acceptability
of PrEP for HIV-negative individuals were driven by concerns about side-effects
and duration.

“People
taking ARVs are only doing it because they are sick. Most fear the side effects
these ARVs come with,” said a woman with HIV. “I don’t like pills because of side-effects…The syringe would be easier than taking pills every day,” said an HIV-negative man. “She must go for ARVs in the time when she tries to conceive
or forever? [If just while she tries to conceive] then she could do this,” said
a man with HIV.

Acceptability
of manual insemination differs between HIV-positive and HIV-negative men.

“Men
don’t want to be robbed of our manhood. It’s not going to be our baby, it is
like it’s someone else’s [if manual insemination is used],” said a man with HIV, while an HIV-negative man stated, “I would use the syringe as long as I
would get a baby and I wouldn’t get the virus. The most important thing is to
have a baby and remain HIV-negative. How the baby is done is not important.”

Misunderstandings
about serodiscordance were also iterated. “The child might get infected,
because even though I’m [HIV-]negative, I don’t think I’m 100% negative. If I
sleep with someone who is negative, I might infect that person,” stated an
HIV-negative woman.

There
is also a limited understanding of female fertility and male insemination, as
displayed in the responses below:

“Is
there a certain temperature that semen need to be to live? Because it might
cool down too much before I put it in.”

“Does
she need to be hot or in the mood?”

“When
there is penetration, you are closer to the cervix. But how will they [semen]
get there?”

Based
on the study, Phofa advocated that “effective safer conception services require
a strong counselling component and a comprehensive approach with multiple
strategies offered to incorporate patient preference, rather than a single
algorithm.”

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends
checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member
of your healthcare team for advice tailored to your situation.